Learning and change

Abstract

Learning and change are intertwined, universal features of modern life. Health professional education often aims to link learning to changes in health outcomes. This thesis examines the relationship between learning, change and improvements in health outcomes. This relationship is explored in three key areas: Continuing Professional Development (CPD) for Physicians, interprofessional education and clinical leadership. The interaction between learning, change and leadership are explored through a mixture of: literature review, applied theory, theory and model development, expository writing and an auto-ethnographic case study. The theoretical approach is based on Jurgen Habermas’ theory of cognitive interests viewed through a community of practice lens. Findings were that the locus of change is a key variable distinguishing between learning theories and change management theory offers a useful perspective on the problem of transfer of learning into practice. The major division in perspective for CPD is that between the individual and organisation viewpoint. Linking professional lifelong learning to improvements in quality of care requires adoption of a variety of perspectives and careful management of the tension between self-directed learning and organisational objectives. This is aided by moving from an “update” to professional learning model of CPD. Interprofessional learning remains a challenge but team meetings provide an opportunity to address core teamwork competencies. A guided reflection tool has been developed to facilitate this. Power remains a major issue inhibiting an ideal speech situation. For leadership they key issue is that the model used in the administration aligns with that used in the clinic and a therapeutic model of leaderships is proposed. Finally the issues raised in this thesis are examined from a community of practice perspective showing that this framework offers the potential for combining individual and organisational views Linking lifelong and interprofessional learning to changes in the quality of care is a major challenge. Factors identified to facilitate this include: integrated models that build upon the learning and change management literature; an appropriate model of leadership; a community of practice perspective and an approach that considers questions not only from a purposive-technical perspective, but considers the importance of hermeneutic and emancipatory considerations.